AB1138 DIFFICULT-TO-TREAT PSORIATIC ARTHRITIS: ANALYSIS OF A SINGLE-CENTER COHORT FROM NORTHERN ITALY
Authors: G. Cincinelli, M. Ferrito, M. Pandolfi, M. Biggioggero, S. Casari, M. Cornalba, C. Crotti, F. Desiati, E. G. Favalli, M. Manara, R. Caporali
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> The multifaceted nature of psoriatic disease can potentially make its skin, articular, and extra-articular manifestation complex to manage. Biologic disease modifying anti-rheumatic drugs (bDMARDs) have dramatically improved the outcome of patients affected by chronic inflammatory arthritis. However, a satisfactory disease control is not achieved in a proportion of patients. While a "difficult-to-treat" (D2T) definition has been validated in rheumatoid arthritis (RA), it was only recently suggested for psoriatic arthritis (PsA) [1]. <h3>Objectives</h3> Based on the proposed definition, we aimed to assess prevalence and characteristics of D2T-PsA in a single-center cohort. <h3>Methods</h3> We conducted a single-center, cross-sectional study. 269 consecutive, adult PsA patients receiving bDMARDs at a tertiary care, dedicated outpatient clinic were enrolled. Demographic, clinical, and clinimetric data, and the Health Assessment Questionnaire (HAQ) were gathered and depicted in Table 1. According to the aforementioned definition, D2T patients were identified as: 1) failure of ≥ 2 b/tsDMARDs (with different mechanisms of action- MoA) after failing csDMARD therapy; 2) signs suggestive of active/progressive disease (defined either as a DAPSA &gt;14 or not achieving MDA; signs or symptoms suggestive of active disease; a rapid radiographic progression; a reduction of quality of life due to PsA symptoms); 3) disease management perceived as problematic by rheumatologists or patients (all three criteria must be met to define D2T patients). Comparison between D2T and non-D2T patients was performed with univariate analyses. <h3>Results</h3> Among 269 PsA patients, only 8 (2.9%) fulfilled D2T definition. In bivariate analysis, D2T patients presented higher rate of osteoarthritis (62.5% vs 24.9%; <i>p=0.03</i>), fibromyalgia (62.5% vs 14.94%; <i>p&lt;0.004</i>), and therapy with steroids (50% vs 12.1%; <i>p=0.008</i>). Furthermore, D2T patients presented significantly higher patient global assessment (PGA 0-10) (7.5 vs 2.00; <i>p&lt;0.001</i>) and VAS pain 0-10 (8.00 vs 2.00; <i>p&lt;0.001</i>). Among non-D2T patients, 24 were in moderate disease activity (9.19%). Due to the unbalance between the groups numerosity, multivariate analysis was not feasible. <h3>Conclusion</h3> Only few patients satisfied the PsA-D2T definition in our cohort; application of a RA-like D2T definition to a heterogeneous disease as PsA should be discussed more broadly in the future. <h3>Reference</h3> [1]Perrotta FM, Rheumatol Ther 2021 Aug;9(4):1193-1201 <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> Gilberto Cincinelli: None declared, Matteo Ferrito: None declared, Marco Pandolfi: None declared, Martina Biggioggero Speakers bureau: Galapagos, Silvia Casari: None declared, Martina Cornalba: None declared, Chiara Crotti: None declared, Francesca Desiati: None declared, Ennio Giulio Favalli Speakers bureau: AbbVie, BMS, Celltrion, Galapagos, Janssen, Lilly, MSD, Novartis, Pfizer, UCB, Consultant of: AbbVie, BMS, Celltrion, Galapagos, Janssen, Lilly, MSD, Novartis, Pfizer, UCB, Maria Manara Speakers bureau: Novartis, Angelini, Consultant of: Lilly, MSD, Roberto Caporali Speakers bureau: AbbVie, Amgen, BMS, Celltrion, Fresenius, Galapagos, Janssen, Lilly, Novartis, Pfizer, UCB, Consultant of: AbbVie, Fresenius, Galapagos, Lilly, Novartis, Pfizer, UCB.